Not long ago, high-quality health care felt out of reach for many families in Rangwe, a community in Homa Bay County. Health facilities were overburdened and underequipped, and services didn’t always reflect what the community needed. Mothers often travelled far or waited too long to receive care, and for some, those delays could be life-threatening.
But that reality is shifting, with change led by the community itself. At Obunga Health Facility, which serves more than 6,000 people in Rangwe, community-led health is transforming health outcomes. Community health workers (CHWs) visit families where they live; facility staff are trained, equipped, and mentored to provide high-quality care; and the community holds the system accountable, making sure care reflects real needs. “When you build solutions with the community, they take ownership,” says Steve Okong’o, Lwala’s County Lead in Homa Bay. “That shared commitment is what keeps the system strong over time.”
Community Health Workers: Every visit is a building block
In 2024, Lwala expanded its community-led health model to Homa Bay County. Bordering Lake Victoria, Homa Bay is home to 1.2 million people, including rural island and lakeshore communities like Rangwe. High rates of poverty contribute to poor health and nutrition, and the main economic activities of farming and fishing are vulnerable to climate change. In response to these challenges, Lwala has adapted its learnings from Migori County to strengthen health systems across Homa Bay, working alongside the county government.
For over a decade, CHWs in Rangwe worked without pay or the up-to-date training they need to support their communities. Many CHWs did not have the right tools to detect pregnancies early and link mothers to antenatal care. Lwala has worked to professionalize CHWs over the past year alongside county government, including the first CHW training in over ten years. Together, we have trained 2,976 CHWs in Homa Bay—advancing a national effort to ensure that Kenya’s CHW workforce has fair pay, supervision, and commodities. Additionally, CHWs now use digital tools while conducting home visits to monitor their caseloads, collect data, and receive decision support. Today, CHWs have registered 99% of households and reach 76% of households each month–a significant increase from 38% of households visited in May 2024, when Lwala first expanded to the county.
One of the biggest impacts has been on maternal health. Trained CHWs mean pregnant women receive the care they need on time and at their doorstep–detecting pregnancies early and walking alongside mothers from the first trimester to delivery.
“We didn’t realize just how much our community was struggling until we were training. When we became aware of the gaps, especially for mothers and children, it was a wake-up call that made us more committed to changing things for the better."
- Joana Atieno, Community Health Worker linked to Obunga Health Facility
At Obunga, CHWs also meet monthly with facility staff to review patient records and coordinate care. “We’ve found that regular mentorship keeps CHWs motivated and effective, helping them support mothers every step of the way, from the first visit to delivery,” says Gerald Hindia, the facility’s Nursing Officer In-Charge. Since the same time period in 2023–before Lwala’s expansion–Obunga has seen a 17% increase in child wellness visits and 22% increase in family planning visits. Additionally, Rangwe maintains a 97% skilled delivery rate.
Health facilities ready to respond
Not long ago, Obunga Health Facility struggled to handle emergencies due to limited staffing and delayed referrals. “There were days when a mother would come in too late, and despite everything we tried, we couldn’t save her,” says Mr. Hindia.
Today, with support from Lwala, Obunga is better prepared for maternal and newborn emergencies. Clinical staff receive ongoing mentorship and training in lifesaving practices–from managing obstetric hemorrhage during childbirth to newborn resuscitation. They are trained and equipped to use critical tools like the non-pneumatic anti-shock garment, uterotonics, and breathing devices for infants. In the past year, working closely with the county, we trained 10 health care workers across Rangwe, including two from Obunga. Most notably, the facility has reported zero maternal or neonatal deaths across 2024 and 2025 to date—highlighting the lifesaving impact of well-supported, skilled providers.
What’s happening at Obunga is part of a wider transformation across Kenya to end preventable maternal and newborn deaths. So far, Lwala has trained 579 health workers and 120 facilities across Homa Bay to turn the tide on maternal and newborn deaths.
“Now, I can say that things are different,” Mr. Hindia says. “In case an emergency arises, we move quickly and with confidence. We are seeing more mothers returning home safely, with their newborns in their arms, and that gives us hope.”
Community Health Committees: Powering change from within
Behind Rangwe’s transformation is the power of community. Across Kenya, community health committees (CHCs) are reshaping how health systems respond to the needs of their people. These grassroots governance structures gather feedback, identify challenges, and work directly with health facilities and local leaders to drive improvements. Lwala has fully activated all CHCs across Homa Bay and trained 211 of its 281 CHCs–75% of all active committees in the county to date. Homa Bay’s first county-wide CHC assessment, conducted by Lwala, revealed that 80% of CHCs in the county are holding government accountable and that women make up 50% of all CHC members–ensuring that maternal and child health remains central to community decision-making.
Using tools like the National CHC Scorecard and National CHC Curriculum—which Lwala co-developed with the national Ministry of Health—Lwala is working with partners to equip CHCs across Homa Bay and ensure health priorities reflect community voices. In Rangwe, when long wait times and staffing shortages impacted the quality of care at Obunga Facility, CHCs advocated for on-site staff housing by meeting with county government in community forums. Through sustained advocacy, the county and CHC committed to co-funding new staff quarters–and today, new housing is under construction, a vital step toward 24-hour service delivery.
Another CHC in Rangwe recognized that the lack of a laboratory in their community was causing delays in care, including diagnostic tests. In response, they successfully advocated to their Health Facility Management Committee to hire a qualified lab technician, whose salary is covered through revenue generated under the Facility Improvement Fund–a government mechanism that allows facilities to retain and reinvest user fees to improve local services.
“People used to bypass this facility because they couldn’t get the services they needed,” says Joshua, a member of the CHC. “If someone needed a lab test, they’d have to travel to another town, sometimes hours away.” Today, with a qualified laboratory technician stationed on-site, pregnant women can access prenatal testing without having to travel long distances–leading to faster diagnoses and improved health outcomes for both mothers and babies.
“We listened to feedback and reimagined what this facility could be,” Joshua reflects. “Now, it’s a place people trust. That transformation happened because the CHC stayed engaged, asked the right questions, and kept pushing for change.”
“Every mother who survives, every child who thrives is a reminder of what’s possible when we walk together. Our goal is to build a system that communities can carry forward, long after we’re gone.”
- Steve Okong’o, Homa Bay County Lead, Lwala Community Alliance
Laying the foundation for a healthier future
Rangwe’s progress shows what’s possible when communities lead. Lwala’s work goes beyond Rangwe, as we work with communities across Kenya to professionalize CHWs, improve the quality of service at health facilities through clinical training, and empower CHCs, while centering leadership and accountability at the local level.
